WHO wheelchair provision guidelines set an aspirational standard for assistive technology service delivery

In April 2023, at the International Society of Prosthetics and Orthotics World Congress in Mexico, the World Health Organization (WHO) launched new Wheelchair Provision Guidelines (World Health Organization, 2023). These Guidelines, developed partly in response to World Health Assembly Resolution 71.8 (World Health Assembly, 2018), are meant to provide national governments, implementers, and advocates with an understanding of those principles and concepts which should be present in equitable and effective wheelchair service delivery systems.

We were fortunate to have front seats in the development of these Guidelines as a member of the Guideline Development Group and as an observer representing the International Society of Wheelchair Professionals, respectively. While the process of guideline development is not without its challenges, particularly considering interventions as complex as wheelchair provision, and with a relative paucity of robust evidence, ultimately the document represents the best available evidence in the area of wheelchair service provision. Where evidence is lacking or needs further development, the experience of global experts in the area guides the recommendations. Making recommendations which can apply equally across low- and high-income contexts, including different cultures and health systems, is difficult, and there will certainly be critics who feel the recommendations do not go far enough, or are not specific enough. However, they represent a starting point which can be adapted to a country’s context, and which can be improved on in the future, as we develop more robust evidence in the areas of policy and service delivery.

Across all domains of assistive technology, we continue to struggle with low-quality evidence, particularly in areas which tend to be difficult to study – the development and implementation of service provision models, the efficacy of those programs and policies, and the outcomes associated with the building blocks of those programs. Arguably, we have better evidence in this area for wheelchair provision than we do across many other assistive products. Consequently, the development of these Guidelines is a welcome step in the right direction and a call to action for future research in the area so that stronger recommendations may be made with better evidence, both for wheelchair service delivery, but also for other assistive products specifically, or the field more generally.

While the Guidelines have been developed specifically for the wheelchair sector, they bear relevance for assistive technology as a field. In the absence of guiding documents for assistive technology service delivery, the principles outlined in these Guidelines will likely be taken up by advocates in all areas of assistive technology. The guidelines include seven recommendations: The need for individualized assessment and selection; preparation and fit of wheelchairs based on the individualized assessment; provision of training for people who use wheelchairs and those who assist them; the need for ongoing follow-up; the provision of wheelchair services by people with role-specific competencies; seamless referral and access to services across the health system; and systematic evaluation of wheelchair services. These seven recommendations are broadly applicable to the field of assistive technology and may signal future guidance from WHO and other organizations on service delivery for other assistive products.

Notably, the new Guidelines are grounded in four principles, and formally introduce a new four-step process to wheelchair service provision. The principles of access to a wheelchair as a human right, wheelchair provision as an integral component of universal health coverage, equitable access to appropriate wheelchairs, and people at the center of wheelchair services and systems act as guideposts for policymakers. The four-step process – Select, Fit, Use, and Follow-Up – provides a simplified approach to the eight steps previously identified in the WHO Guidelines on the Provision of Manual Wheelchairs in Less Resourced Settings (World Health Organization, 2008), which has been a strong guiding document for the sector since its publication.

Regardless of whether your focus is in the wheelchair sector or another area of assistive technology, these guidelines represent a clear and concrete next step for assistive product provision. They also represent a clear research call to action for improved evidence in service provision and assistive technology policy. The Assistive Technology Journal and International Society of Wheelchair Professionals welcome the publication of these Guidelines and congratulate the WHO and the team of volunteer contributors on the accomplishment of this milestone. Further, the Assistive Technology Journal encourages submissions of manuscripts exploring policy development and evaluation or research which explores the efficacy of service provision models, including the outcomes of aspects of service provision on recipients of those services.